Clinical Neuroscience

[Phrenic nerve pacemaker- the first implantation in Hungary]

KLAUBER András1, MORVAY Balázs2, GERHARD Exner3, PASI Talonen 4

JULY 20, 1997

Clinical Neuroscience - 1997;50(07-08)

[As a result of a traffic accident on July 15, 1994 a 20 years-old girl immediately became tetraplegic at the C2 level. She had no spontaneous respiration and she needed a respirator. The neurological status has not changed, the total spinal cord lesion has not improved. Her general condition was satisfactory after the treatment of complications (some pneumonia, decubitus, etc.). She underwent an operation on May 31, 1995 and she was given a phrenic pacemaker. The equipment has been working without any problem for fifteen months. Although phrenic nerve pacing is not new for experts, our case is worth presenting since she was the first in Hungary who survived the high cervical spine injury. She lives at home without a respirator, restrained but yet tolerably. ]


  1. MÁV Kórház, Mozgásszervi Rehabilitációs Osztály, Budapest
  2. Vas megyei Markusovszky Kórház, Aneszteziológiai és Intenzív Betegellátó Osztály, Szombathely
  3. Berufsgenossenschaftliche Unfall-Krankenhaus, Hamburg, Németország
  4. University of Technology, Tampere, Finnország



Further articles in this publication

Clinical Neuroscience

[Patient characteristics at the stroke unit of a clinical department of neurology during a 12-month period - methods of database management, demographic characteristics and inhospital mortality]


[Hungary is among the countries with the highest rates of stroke mortality. Accuracy of data in international statistical reports have been crlticized by several authors. The aim of the present study was to give a methodological description of the database, to report basic patient characteristics and to discuss causes of discrepancies between national and hospital stroke morbidity and mortality data. Data from a stroke unit with a catchment area of 210 000 inhabitants were used to create a database from about 100 parameters per patient discharged from the stroke unit during a 12-month period. During this period 505 patients with acute stroke were treated at the stroke unit. Of the patients admitted 15% did not have stroke. Fatality among inpatients with acute stroke was 18.6% (n=94). Assuming that all stroke patients of the catchment area were treated at the stroke unit and that stroke mortality in the catchment area equals that of the national value, 410 deaths should have occurred at the unit. The discrepancy between the number of the expected and detected stroke fatality cases might imply that either a large number of stroke patients from the catchment area do not reach the stroke unit, or actual stroke mortality is lower in our region than the national average. To examine these hypotheses, a population based prospective study should be performed. ]

Clinical Neuroscience

[Experiences of surgically treated temporal epileptic patients - multicentre study ]

BALOGH Atilla, BORBÉLY Katalin, CZIRJÁK Sándor, HALÁSZ Péter, JUHOS Vera, KENÉZ József, VAJDA János

[Our experiences on surgically treated temporal lobe epileptic patients are presented. Involved in the disease are the process of preoperative investigations, clinical data, types of operation and their indications, and the postoperative controls. Pre- and postoperative data of 36 surgically treated, intractable temporal lobe epileptic patients were analysed. A postoperative follow-up of longer than two years was carried out on 24 patients. The experiences of these patients on postoperative seizure frequency were evaluated using Engel's classification. Among these 24 temporal lobe epileptic patients 19 are seizure free (Engel I.), the seizure frequency significantly decreased in 3 of them (Engel II.), in the case of 2 patients the number of seizures was reduced (Engel III.). Our experiences show that neurosurgical investigation seems to be an increasingly useful, alternative way for treating intractable temporal lobe epileptic patients.]

Clinical Neuroscience

[Lumbar pseudoradicular pain part 1: anatomical principles]

KASÓ Gábor, DÓCZI Tamás, DÁVID Károly

[Most low back and leg pain, caused by degenerative disorders of the lumbar spine can be classified as referred (projected) pain. One of the types of referred pain is pseudoradicular pain originating from the characteristics of innervation of the spinal motion segment. Ventral parts of the spinal motion segment are supplied by the sinuvertebral nerve and the sympathetic nervous system, while the dorsal compartment is innervated by dorsal rami of the spinal nerves and both systems show considerable segmental overlap]

Clinical Neuroscience

[Gasoline caused hexacarbon polyneuropathy - description of five cases]

VIDA Zsuzsanna, FOLYOVICH András, GÁCS Gyula

[Based on five cases a description is given n-hexane induced polyneuropathy caused by laundry cleaning gasoline, a kind of exposition that has not been published up till now. The symptoms (subacute sensomotor polyneuropathy) and the peculiar course (further deterioration after the exposition has ceased) of hexacarbon polyneuropathy caused by gasoline were similar to that of other cases induced by other n-hexane containing materials such as diluting agents, glues, lacquers etc.]

Clinical Neuroscience

[Short- term video EEG analysis in a useful tool in the diagnosis of epileptic phenomena]


[Short-term (30–120 min) video- EEG recording and split-screen analysis is a very useful tool in investigating short- lasting epileptic or non- epileptic phenomena. The authors use this technique in different clinical situations as follows: frequent seizure- like episodes of suspected or proven epileptic etiology, with special reference to absence like and myoclonus- like episodes; motor manifestations, paroxysmal psychic phenomena, and fits induced by visual stimulation. Further indications were as follows: long-lasting pathological stupor states of suspected epileptic origin, long-lasting EEG discharges with unclear clinical correlations, precise analysis of partial epileptic seizures. The results show that, depending on patient selection, video- EEG analysis significantly contributed to precise diagnosis of epileptic seizures as well as to differentiation between epileptic and nonepileptic fits. In a few cases, rare, unsuspected epileptic conditions could only be identified by means of video- EEG analysis. The paper has been completed with a few brief illustrative case reports.]

All articles in the issue

Related contents

Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]


[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]


[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.